Transthoracic, thoracoabdominal, and transabdominal surgical approaches for gastric cardia adenocarcinomas: a survival evaluation based on a cohort of 7103 patients.

BACKGROUND: This study compared the survival outcomes of different surgical approaches to determine the optimal approach for gastric cardia adenocarcinoma (GCA) and aimed to standardize the surgical treatment guidelines for GCA. METHODS: A total of 7103 patients with GCA were enrolled from our previously established gastric cardia and esophageal carcinoma databases. In our database, when the epicenter of the tumor was at or within 2 cm distally from the esophagogastric junction, the adenocarcinoma was considered to originate from the cardia and was considered a Siewert type 2 cancer. The main criteria for the enrolled patients included treatment with radical surgery, no radio- or chemotherapy before the operation, and detailed clinicopathological information. Follow-up was mainly performed by telephone or through home interviews. According to the medical records, the surgical approaches included transthoracic, thoracoabdominal, and transabdominal approaches. Kaplan-Meier and Cox proportional hazards regression models were applied to correlate the surgical approach with survival in patients with GCA. RESULTS: There were marked differences in age and tumor stage among the patients who underwent the three surgical approaches (P < 0.001). Univariate analysis showed that survival was related to sex, age, tumor stage, and N stage (P < 0.001 for all). Cox regression model analysis revealed that thoracoabdominal approach (P < 0.001) and transabdominal approach (P < 0.001) were significant risk factors for poor survival. GCA patients treated with the transthoracic approach had the best survival (5-year survival rate of 53.7%), and survival varied among the different surgical approaches for different tumor stages. CONCLUSION: Thoracoabdominal approach and transabdominal approach were shown to be poor prognostic factors. Patients with (locally advanced) GCA may benefit from the transthoracic approach. Further prospective randomized clinical trials are necessary.

Advances in the protection of intestinal mucosal barrier function by milk-derived miRNAs.

Milk is a significant component of the human diet, providing an abundance of energy and nutrients and a variety of functional factors. Recent studies have revealed that milk is highly enriched in exosomes with intercellular communication functions, which can act on target cells in vivo by carrying and delivering miRNAs and critically participating in physiological processes such as host intestinal development, cell differentiation, and immune response. In recent years, the biosynthesis of milk-derived miRNAs and their cross-border uptake mechanisms, the biological functions of milk-derived miRNAs and the universality of their regulatory modalities, the extraction and identification of milk-derived miRNAs as novel active ingredients and their potential as biomarkers have been extensively studied. Accordingly, this paper compares and summarizes the cutting-edge research on the nutritional and health functions of milk-derived miRNAs, including the types and contents of milk-derived miRNAs, their transportability and stability in the digestive tract, with special attention to the molecular mechanisms of the milk-derived miRNAs in protecting the barrier function of the intestinal mucosa, and looks forward to the application of milk-derived miRNAs as novel dietary supplements in infant foods and functional foods. It will inform future efforts to elucidate the profound impact of milk-derived miRNAs on the human intestine and broader health.